Knowledge of Substance Abuse
Among High School Students in Jordan
Journal of Transcultural Nursing
21(2) 143­–150
© The Author(s) 2010
Reprints and permission: http://www.
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1043659609357632
http://tcn.sagepub.com
Linda Haddad, PhD, RN,1 Ali Shotar, MD, PhD,2
Mary Umlauf, PhD, RN,3 and Sukaina Al-Zyoud, MSN, RN4
Abstract
Objectives: The purpose of this study was to explore the knowledge, attitude, and beliefs about substance abuse among
Jordanian adolescents (aged 15-18 years). Design: A descriptive design was employed using a self-administrated questionnaire
to collect the data from 400 high school students. Methods: A multistage, random sample was generated in selecting schools
from the educational directorate located in a large urban city located in the north of Jordan.This city district contains 23 public
secondary schools and serves 56.8% of the adolescents in the entire province. Results: The results revealed the following:
Students of both sexes were knowledgeable about aspects of substance abuse, including its harmful effects on the body and
society and reported that even occasional or frequent use of cigarettes, alcohol, and other drugs was extremely harmful. A
majority of the students perceived substance abuse as a problem, although the older students were more acutely aware than
the younger group. However, the results revealed that the students lack in-depth knowledge of substance abuse. In addition,
the adolescents consistently refer to Islamic principles forbidding use of intoxicants but mistakenly presume that mosques
are sources for assistance regarding substance abuse. Conclusions: Policy makers, health workers, and religious leaders
must collaborate to build structured educational programs and readily accessible, evidence-based treatment programs for
adolescents. Given that young people constitute the majority of the Jordanian population and that drug trafficking is prevalent
in the region, the implications of prevention programs are critical to maintaining gains in public health outcomes as well as
economic progress and development in Jordan.
Keywords
adolescent, students, developing countries, Middle East, substance abuse, Jordan
Although Jordan is known for its conservative Islamic values,
drug use has become increasingly common. Because a significant proportion of Jordan’s population is young, increased
use of nicotine, considered a gateway drug, and hard drugs
are a significant health concerns. In 2005, Jordan’s population was 5,703,000, with an annual growth rate of 2.9%
(Hashemite Kingdom of Jordan, 2003; World Health Organization, 2007). Young adults (15-29 years of age) represent
31% of the population—the largest group in Jordanian
society. Almost 60% of the population is younger than 25
years and 38% younger than 15 years (Muzio et al., 2000;
United Nations, 2006).
In contrast to the historic and cultural prohibition of
smoking among youths in Jordan, a recent report on adolescent (13-15 years of age, N = 7,088) smoking documented
the following: 44% have smoked, 21% currently smoke, and
25% of never smokers reported that they were likely to initiate smoking in the next year. Many teens (33% boys, 27%
girls) held the belief that smokers had more friends; others
(26% boys, 20% girls) thought smokers were more attractive.
Furthermore, more juveniles saw procigarette ads (7 out of
every 10) than antismoking media messages in the 30 days
prior to being surveyed (Centers for Disease Control and
Prevention, 2003). Smoking behavior has also changed in
the recent past, influenced by peer pressure and the popular
media. For example, cigarette smoking in public by teenagers, especially males, has become extremely common. This
is in stark contrast to the Jordanian legal prohibition of
smoking for those aged less than 18 years (Ghouri, Atcha, &
Sheikh, 2006). Studies of Jordanian college students reported
a smoking prevalence of 28.6%, and some respondents (17%)
also reported smoking before the age of 15 years (Haddad &
Malak, 2002; Haddad & Petro 2006).
1
Virginia Commonwealth University, Richmond,VA, USA
Jordan University of Science and Technology, Irbid, Jordan
3
University of Alabama, Tuscaloosa, AL, USA
4
Hashemite University, Zarqa, Jordan
2
Corresponding Author:
Linda Haddad, PhD, RN, School of Nursing,Virginia Commonwealth
University, Richmond,VA 23298, USA
Email: [email protected]
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Journal of Transcultural Nursing 21(2)
Figure 1. 2005 Population of Jordan by age-group (U.S. Census
Bureau, 2005)
Tobacco is considered a “gateway drug” that may lead to
alcohol, marijuana, and other drug abuse as well high-risk
behaviors in the long term (National Center on Addiction
and Substance Abuse, 2007; Tapert, Aarons, Sedlar, & Brown,
2001). That is, use of an addictive substance before the age
of 15 years significantly increases the risk for future substance
use and abuse. This is in contrast to the risk for initiation of
use of all substances, which decreases by the age of 20 years
(Lynch & Bonnie, 1994). Other investigators have shown
that risk for initiation of use of alcohol and marijuana is greatest between the ages of 16 and18 years, with 18 years being
the most venerable time for initiation of illicit substance use
of any type (Andrews, Tildesley, Hops, Duncan, & Severson,
2003; Graham, Marks, & Hansen, 1991).
According to law enforcement agencies in Jordan, the
scope of illicit drug problem began to expand in 1995. A report
from 2000 documented that most drug abusers were male
(94%) and between the ages of 20 and 35 years (Muzio et al.,
2000). Data from 2003 showed a 200% increase in the number
of drug offences between 1994 and 1999. In 1999, there were
775 cases of drug use and drug dealing (Hashemite Kingdom
of Jordan, 2003). In 2000, heroin users were mainly located
in pockets in border cities and the capital city, Amman. Today,
drug use has penetrated into villages and rural areas in
Jordan. The situation is alarming not only in Jordan but also
in the region. For example, it is estimated that 15% of young
people in Israel use drugs (Brook, Feigin, Sherer, & Geva,
2001), and 25% of high school students in Iran were experiencing problems with at least one illegal drug (Ahmadi,
Rayisi, & Alishahi, 2003).
A number of factors contribute to the illegal drug problem
in the region. Historically, Jordan has been the crossroads of
the East/West and North/South routes of commerce in the
Middle East. Jordan also borders, or is in close proximity to,
economically disadvantaged countries that produce drugs.
Some hypothesize that drug use has expanded owing to
factors such as the migration of the rural poor to the larger
cities, a decline in illegal drug prices, and the recent influx of
Iraqi refugees.
Intoxicant use and addictive drug use among adolescents
is a worldwide problem. Alcohol consumption, tobacco, and
other illicit drugs among U.S. teens are associated with
injury and death, including motor vehicle accidents, suicidal
behavior, violence, accidental falls, drowning, unprotected
sexual behavior, and cancer (Karch, Lubell, Friday, Patel, &
Williams, 2008; Substance Abuse and Mental Health Services Administration [SAMHSA], 2002). Adolescents often
report that drugs help them to deal with their anxiety and
overcome depression (O’Malley, Johnston, & Bachman,
1998). They believe that drug use improves coping with personal difficulties in their personal, social, and school life. It
is assumed that experimentation with intoxicating and addictive substances begins in adolescence because this is the
period of life for exploration and experimentation (SAMSHA,
2002). Adolescents are cognitively immature and vulnerable
to experimentation with drugs because of social influences
and commercial marketing strategies. Recent reports have
documented a global increase in addictive drug availability
and consumption and a pattern of vulnerability among those
aged between 15 and 25 years (Johnston, O’Malley, & Bachman, 2001; Johnston, O’Malley, Bachman, & Schulenberg,
2006). Nearly half (43%) of teenagers aged between 15 and
16 years and a quarter of those aged between 13 to 14 years
have already tried illicit/addictive drugs (Johnson & Leff,
1999).
Thus, there is increasing need to address substance use
among young Jordanians to forestall future problems with
hard drugs. Very little is known about the knowledge, attitudes, and beliefs regarding substance use among Jordanian
adolescents. Experts in the field state that normative beliefs
about drug use and drug-related behavior play a crucial role
in developing effective school-based drug education programs (Florin, Mitchell, & Stevenson, 1993). Without
proper evaluation of the adolescent population prior to creating national prevention programs, this vulnerable group
may not receive the most relevant and potentially effective
interventions regarding drug education. Thus, the purpose
of this study of Jordanian adolescents (aged 15-18 years)
was to answer the following questions:
1. What do these adolescents know about substance
abuse?
2. What do they believe about the consequences of
substance abuse?
3. What are their attitudes about substance abuse?
For the purpose of this study, attitude and beliefs toward
the target behaviors are defined as the person’s previous
attitude toward that behavior. This assumes that individuals
think about their decisions and the possible outcomes before
making a decision. There is an attitude formed about the
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145
Haddad et al.
overall decision and the object of that decision. Subjective
norms (beliefs) include the individual’s belief that specific
individuals or groups think that he should or should not perform a behavior and the motivation to comply with these
influential persons.
Method
Population and Study Sample
A multistage, random sample was generated by selecting
schools and students from the educational directorate located
in a large urban area in northern Jordan. The school district
has 23 high schools, which represents 56.8% of the adolescents in the entire governorate. The total enrollment of these
schools was 7,818 students, 5,055 enrolled in schools for
boys and 2,763 in schools for girls. The sample size was estimated to be 400 students. Thus, the system for selecting
participants was as follows: Six individual schools were randomly selected by drawing the names of schools from a hat.
After that, two individual classes of students were selected
randomly from each school using a simple random sampling
technique until the sample size of 400 was achieved.
Table1. Sample Demographics (N = 400)
n
Age-group
15-16 years
197
17-18 years
203
Sex
Male
193
Female
207
Year of school
Tenth grade
160
Eleventh grade
240
Living with parents
386
Head of household—employment
Unemployed
41
Farmer
6
White-collar job
73
Blue-collar job
48
Governmental job
152
Head of household—highest level of education
Illiterate
26
Seventh grade
46
Twelfth grade
149
Community college degree
27
University degree
85
Graduate degree
66
%
49.3
50.8
48.3
51.8
40
60
96.5
10.3
1.5
18.3
12.0
38.0
6.5
11.5
37.3
6.8
21.3
16.5
Instrument
A self-administered pencil-and-paper questionnaire was used
to collect data on knowledge, attitudes, beliefs, and practices
regarding substance abuse. This questionnaire was developed
in 2002 by National Agency for the Treatment and Rehabilitation of Substance Abusers in Bangladesh (Ahmed, Rana,
Chowdhury, Mills, & Bennett, 2002) to survey young people
(aged 12-24 years) regarding substance use. However, the
original questionnaire did not report any validity and reliability. The instrument was translated into Arabic using a
comprehensive method to ensure equivalence and validity.
The method requires translation from English to Arabic, then
back-translation from the Arabic version to English to validate
equivalence. The translated version and original instrument
were also reviewed by a committee comprising four experts in
the topic who were competent both in Arabic and English languages to consider the equivalence of terms, clarity, and
cultural adaptation. Minor modifications were made according to committee recommendations. The instrument consisted
of 30 items in the following four sections: (a) knowledge
about substance abuse and attitudes and beliefs toward substance abuse, (b) awareness of structures for social problems,
(c) modes of life counteracting substance abuse, and (d)
awareness of health, socioeconomic, and sociocultural problems associated with substance abuse. A pilot study (n = 40)
was conducted to test the data collection procedures and to
compute the reliability coefficient of the Arabic version of the
instrument. The findings of the pilot study indicated that the
instrument was reliable (a = .93), had an appropriate reading
level, was easy to understand, and was comprehensive.
Data Collection and Ethical Issues
The committee for protection of human subjects at Jordan
University of Science and Technology approved the study
design and consenting methods prior to beginning the study.
Investigators contacted the regional director of schools and
obtained official access to students. A brief description of the
study purpose was given to students before the questionnaire
was distributed, and voluntary consent was obtained. Participants were informed that their responses would be kept
confidential and that all results would be presented as an
aggregate. Data were collected from two classes of students
at each study site on the same day, and identical instructions
were given to each class.
Results
Demographic Data
Questionnaires were distributed to randomly selected classes
of 10th- and 11th-grade students (N = 430), and a total of
400 students completed the questionnaire resulting in a
93.5% response rate. Table 1 shows the demographical data
of the study sample. The participants ranged in age from
15 to18 years; about 45% were 16 years old and 44% were
17 years old at the time of data collection. Male and female
participants were almost equally distributed; about 60% were
11th-grade students whereas 40.% were in the 10th grade.
Nearly all students (96.5%) reported that they lived with
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146
Journal of Transcultural Nursing 21(2)
Table 2. Knowledge of Health, Social, and Economic Consequences of Substance Abuse Compared by Grade Level (N = 400, df = 1)
Nothing happens to the health of a substance abuser.
A substance abuser always has unsatisfactory health.
A substance abuser develops respiratory diseases.
A substance abuser develops heart diseases.
A substance abuser spends money for nothing.
A substance abuser finally drops out of school.
A substance abuser always runs short of money.
A substance abuser gets sacked from employment because of irresponsibility.
The family of a substance abuser as head always experiences poverty.
Substance abuse is against the norms of society.
The substance abuser and his family is looked down by others
People do not like the company of substance abusers.
Substance abusers are considered as a burden to society.
People do not confide in substance abusers.
their parents and that their families consisted of more than
6 members.
Knowledge About Substance Abuse
Most respondents (70.5%) had heard of substance abuse, and
nearly half (49.5%) knew about various forms of substance
abuse including intoxicating drugs such as marijuana, cocaine,
and psychotherapeutic drugs. On the other hand, 32.3% did
not know the consequences of smoking a single cigarette.
Less than one third (28%) of the subjects knew of individuals or institutions that assist people with the substance
abuse problems, and few (17.8%) were aware that there were
treatment centers for substance abusers. Even fewer (11.8%)
thought that mosques might offer assistance in dealing with
substance abuse.
When subjects were asked about institutions that assist
with drug problems, one third (33.3%) were not aware of any
institutions. Among those who were aware of institutions
that assist, half (50.3%) of the students indicated that they
were sure that these institutions were accessible. More than
half (56.3%) of the participants who were aware of these
institutions believed that they were helpful for adolescents.
However, few subjects identified local youth centers (15.8%)
or voluntary organizations (13.5%) as resources for adolescents with social and personal problems. Most subjects were
aware of the consequences of substance abuse, such as smoking as a cause of heart and lungs diseases (91%), alcoholism
resulting in conflict with the family members (42.2%) and
loss of job (29%), illicit drug use contributing to mental
problems (27.8%), social ostracism (26.8%), and legal fines/
imprisonment (33.8%).
Almost half of the sample stated that they were aware
of problems related to substance abuse (see Table 2).
The majority believed that substance use would lead to
Grade 10 Yes/No
Grade 11 Yes/No
Total (%) Yes/No
p
Value
33/127
119/41
135/25
132/28
138/22
134/26
131/29
137/23
100/60
137/23
133/27
126/34
127/33
126/34
61/179
206/34
212/28
213/27
210/30
206/34
213/27
206/30
120/129
218/22
196/44
207/33
200/40
205/35
24/76
81/19
87/13
86/14
87/13
85/15
86/14
87/13
55/45
89/11
82/18
83/17
82/18
83/17
.000
.000
.000
.000
.000
.000
.000
.000
.51
.000
.000
.000
.000
.000
unsatisfactory health, respiratory problems, and heart diseases. Most subjects believed that substance use could lead to
dropping out of school and loss of employment. Most students were also aware that substance abuse was not socially
acceptable and could lead to social ostracism for the abuser
and their families. Furthermore, substance abusers were
viewed as a burden to society. One third of the participants
rated their knowledge of substance abuse as “very good.” More
11th-grade students reported that they had heard about substance abuse when compared with the 10th-grade students
(c2 = 57.220, df = 1, p = .000).
Attitudes About Substance Abuse
Table 3 shows that majority of subjects believe that substance abuse was a problem among adolescents. However,
the older participants (11th-grade class) were more acutely
aware of drug abuse as a problem than the younger group
(c2 = 46.54, df = 2, p = .000). When participants were
asked how the adolescents should resist the substance
misuse, they suggested several alternatives to counteract
the urge for substance misuse (see Table 3). The frequently
mentioned alternatives were avoiding the pressure of
peers, thinking of substances as a killer, and staying away
from places that sell drugs (30%, 17%, 11%, respectively).
In relation to participants’ perception of substance abuse
as a problem, two thirds (65%) perceived substance misuse
as a problem among adolescents.
Beliefs About Substance Abuse
The adolescents also believed that occasional cigarette smoking, alcohol drinking, and illicit drug use were extremely
harmful (36%, 72.8%, and 87%, respectively; see Table 4).
Likewise, frequent use of cigarettes, alcohol, and illicit drug
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Haddad et al.
Table 3. Techniques to Resist the Urge to Use Drugs Compared by Grade Level (N = 398)
Grade 10
Grade 11
Total (%)
df
p Value
56
19
18
2
2
3
59
64
49
25
30
15
22
32
30
17
11
8.3
4.3
6.3
22.8
1
2
2
1
1
1
2
.048
.023
.058
.000
.008
.002
.000
Resist peer pressure
Always think of drug as a killer
Stay away from places where drugs are sold/consumed
Practice sports/indoor or outdoor activities
Get involved in social work
Look down on drugs consumption
Do not know
Note: Total values may not add up to 100% because of missing responses.
Table 4. Consequences Using Drugs Based on Frequency of Use
(N = 400)
Table 6. Beliefs About Occasional Cigarette Use Compared by
Grade Level (N = 400)
Extremely
Somewhat Not too Not
Grade Harmful Harmful Harmful Harmful Harmful Total
Cigarettes
(%)
Alcohol
(%)
Occasional use
Extremely harmful
36.0
72.8
Harmful
35.8
19.8
Somewhat harmful
22.5
5.3
Not too harmful
3.0
1.0
Not harmful
2.8
1.3
Frequent use
Extremely harmful
57.0
84.0
Harmful
31.0
10.5
Somewhat harmful
8.3
2.8
Not too harmful
1.5
1.0
Not harmful
1.3
0.8
Other
Drugs (%)
87.0
9.0
2.3
0.3
1.5
93.3
2.5
1.5
1.0
0.8
Note: Total values may not add up to 100% because of missing responses.
Table 5. Symptoms of Drug Withdrawal and Methods to Stop
Using Drugs (N = 400)
Cigarettes Alcohol
Other
(%)
(%)
Drugs (%)
Symptoms of drug withdrawal
Bouts of fits
14.8
11.5
Fainting
13.3
19.0
Nausea and vomiting
8.5
28.3
Becomes aggressive
19.0
14.5
Nothing (no harm)
25.0
3.5
Do not know
17.8
21.8
Methods to stop using drugs
Counseling
30.3
5.0
Medical treatment
10.3
24.8
Through prayers
15.8
32.
Just quit and forget
18.3
13.5
Do not know
25.5
24.3
23.8
11.5
9.5
33.0
3.8
17.0
4.3
17.5
22. 8
30.0
24.8
Note: Total values may not add up to 100% because of missing responses.
was viewed as extremely harmful for adolescents (57%,
84%, and 93.3%, respectively; see Table 5).
One quarter of the participants believed that nothing harmful would happen to a regular smoker if he was deprived of
Ten
Eleven
Total
80
64
144
48
95
143
25
65
90
5
7
12
2
9
11
160
240
400
Note: c2 = 24.78; df = 4; p < .000.
cigarettes. A similar number of subjects (28.3%) identified
that an alcohol drinker might manifest nausea and vomiting
during withdrawal. A third of the subjects (33%) believed that
an addict might become aggressive when deprived of drugs.
More than two thirds (68.8%) of teens believed that a tobacco
addict can quit cigarette smoking, only half (50.5%) believed
that an alcoholic could quit drinking, and just less than two
thirds (63.5%) believed that a drug addict could not abstain.
As for methods of quitting substances, many adolescents
believed in the power of counseling (smoking), prayer (alcoholism), and forgetting (drug abuse).
The majority of participants (77.3%) believed that adolescents should be supported in efforts to resist the temptation
for substance abuse. Nearly one third (32.0%) of participants
proposed having information, education, and communication
campaigns against substance abuse. These students believed
that the main sources of information regarding substance
abuse were parents and relatives (48.5%) along with friends/
classmates and teachers (25.0%). In a separate analysis (see
Table 6), the older students (11th grade) reported that occasional cigarette smoking as more harmful than the younger
cohort reported (c2 = 24.782, df = 4, p = .000).
Discussion
The results of the current study point out that Jordanian adolescent have a basic understanding of the nature of substance
abuse and cigarette smoking. Subjects were also knowledgeable about the health, socioeconomic, and sociocultural
implications of substance abuse. However, this raises the
question as to the source of information on substance abuse.
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Journal of Transcultural Nursing 21(2)
On one hand, this knowledge might reflect improved access
to the mass media (i.e., Internet, satellite TV channels), resulting from improvement in the economic status of the families
in Jordan or to the higher educational status of adults in Jordan.
Jordan’s adult population has a very high literacy rate (90%),
which is a reflection of the high primary, secondary, and tertiary gross enrolment (Daghistani, Dajani, Hakki, Nimri, &
Quilliam, 2004). On the other hand, others assert that knowledge of substance abuse among adolescents may reflect their
exposure to drug use within their peer group (Htoon, Myint, &
Thwe, 1999). This may be less likely, however, because of
the extreme social restrictions on illicit drug use in this
conservative Islamic culture.
A high percentage of the students believed that a smoking
habit could be alleviated with the aid of counseling. On the
other hand, many students believed that addictions to alcohol
and illicit substances were enduring. These erroneous beliefs
speak about the limited knowledge among these adolescents
about addictive substances as well as the lack of educational
programs on the topic. Typically, most people in Jordan have
little first-hand knowledge of these problems because of the
long-standing history of social stigma, shame, and isolation
associated with illicit drugs. Drug abuse is so onerous in the
community that citizens will notify law enforcement agencies
to arrest drug abusers in their families.
When asked how adolescents should deal with exposure to substance abuse, a majority of the subjects believed
that they should “resist” drug use. Consistent with another
study of teens in the region, they acknowledged the negative influence of peer pressure (Haddad & Malak, 2001;
Kofahi & Haddad, 2005; Teichman, Rahav, & Barnea,
1987). This finding is also congruent with the others that
report that peer pressure is a predisposing factor for multidimensioned adolescent behavior (Bank, Marlowe, Reid,
Patterson, & Weinrott, 1991; Griffin, Botvin, Nichols, &
Doyle, 2003). However, the notion of resistance is countered by findings from the Global Youth Tobacco Survey
where Jordanian teens thought that smokers had more friends
and were more attractive (Centers for Disease Control and
Prevention, 2003).
The data also show that these young subjects believed
that both occasional and frequent use of cigarette, alcohol,
and other drugs is extremely harmful. These data are not
surprising because of the newsworthiness of drug busts in
Jordan and the strong cultural mores. Geographically, Jordan
lies in the path of drug exporters and buyers in Saudi Arabia,
Syria, and Israel. As a result of increasing drug activity
nationally and regionally, the government has begun airing
public announcements regarding drug trafficking and addiction on television, in newspapers, and in brochures distributed
to school students. This is in direct contrast to more conservative Middle Eastern countries that have denied that
drug abuse exists within their borders. Because of this recent
media emphasis on drug problems and the legal consequences,
drug abuse is discussed more freely in all social venues and
may have shaped some of the responses by this sample of
adolescents.
Health education implications have also emerged from
the data. For example, these teens were uninformed about
where to seek help when faced with problems related to substance abuse. The majority reported that they did not know
any individual or organization that might provide assistance
to young substance abusers. This particular finding highlights a vital piece of information to include in future health
education programming for this age-group.
Social and cultural implications are also important issues
drawn from the findings of this study. Because preventing
substance abuse among adolescents has not been included in
the strategic plan of the Jordanian Ministry of Health or the
United Nations, there have been no formal public health campaigns to develop or market substance treatment services. At
present, most treatment resources that exist are situated in the
capital city, Amman. In smaller communities, however, existing social norms might deter efforts to develop or market
treatment programs. That is, potential users in smaller communities may view treatment programs as stigmatizing, even
though they would be needed services. The climate of social
stigma associated with substance abuse is a barrier to educating the population about the nature of these problems and
help-seeking behavior.
Even though the young respondents thought that religious
organizations and mosques were resources for help, there are
no such programs in the area. Also, the students surveyed
indicated that spirituality (praying) was one method to address
substance abuse. These two findings suggest that older youths
may gravitate toward religious organizations for assistance
with addiction, whereas health care providers typically treat
addiction as a physical disorder. However, there has been
controversy among public health experts surrounding the
idea of using religion as a tool of public health intervention.
The concern is that religious institutions and authorities may
become the main public health players and overshadow weaker
public health institutions (Jabbour & Fouad, 2004). Although
a given program related to smoking or drugs, for example,
may be successful, religious authorities might extend their
influence to another health issue, such as family planning.
The unintended consequence would be that religious custom
would direct important health initiatives that should be driven
by health precepts.
Given this emphasis on the role of Islam in the responses
of the subjects, it is relevant to review some of the beliefs
and attitudes held by Muslims. Although Jordan is not 100%
Muslim, the predominant culture is based on Islamic principles. This includes the judicial system as well as principles
of common law. For example, Islam does not accept or tolerate behaviors that may harm or threaten the body or the soul.
Substance abuse and use of intoxicants, in particular, are
both considered destructive to the body as well as destructive
to the social structure of the community. Drug abuse is seen
as unclean or causing the individual to become unclean.
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Haddad et al.
Ritual bathing is symbolic of physical cleanliness that is
required before prayer, which occurs five times a day. Thus,
the Islamic culture/religion does not tolerate habits that predispose the person to be dirty or to lack motivation to wash,
as occurs with addiction to hard drugs.
Because of the invisible nature of physical addiction, this
type of malady may be viewed as a form spiritual punishment
in Islamic cultures. For example, the concept of jihad is often
used as a synonym for “making war” when it is meant to
describe “taking on a spiritual challenge.” That is, addiction
may be interpreted as a temptation or spiritual challenge from
Allah. Muslims are encouraged to use Islamic principles and
prayer to solve and mitigate problems of the human condition; this is the true meaning of jihad. In Islam, religiosity
and spirituality are viewed as tools in developing approaches
and solutions to deal with substance abuse as well as other
forms of illness or disability. Thus, this adolescent sample
readily identified the cultural role that Islam is expected to
play in dealing with the use of illicit substances at the spiritual, personal, and community levels.
Nursing Practice Implications
The findings of this study provide the basis for developing
comprehensive prevention programs that are directed to adolescents, families, at-risk populations, and the public. These
programs should encompass selective school-based, parent
training, and television programs and should be based on
relevant research findings among Arabs and Jordanian
adolescents. The educational programs should include information concerning addiction and forms of treatment as well
as appropriate treatment services. School and public health
programs must address the importance of smoking avoidance/
cessation and the addictive nature of nicotine as a gateway
substance. Jordanian nurses need to be trained in the signs
and symptoms suggestive of substance abuse and high-risk
behaviors.
Limitations
The region where the participants’ schools were located is
primarily rural, and the population is dispersed across a large
geographic areas. There are two large universities in this
area, and the majority of Jordanians are university educated.
However, the findings of this study may not reflect the characteristics of youth in the more densely populated capitol
city, Amman, where substance abuse is more common and
more serious. Findings from this research, thus, should
remain tentative until more studies are conducted in regard
to substance abuse.
Summary
In conclusion, the results of this study offer important directions for developing programs on drug abuse prevention for
adolescents. These programs need to focus on school settings
and local public health organizations to address the developmental level and perceptions of this vulnerable population.
These programs should also be initiated at both the local and
national levels to maximize effects and for efficiency. Given
that young people constitute the majority of the Jordanian
population today, the implications of prevention programs
are extremely important to continued economic progress
and national development. Young adults and adolescents
represent the future of Jordan; a healthy today will support a
healthy tomorrow.
Declaration of Conflicts of Interest
The authors declared no conflicts of interest with respect to the
authorship and/or publication of this.
Funding
The authors received no financial support for the research and/or
authorship of this article.
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